The Annual Open Enrollment Period is fast approaching (Oct 15- Dec 7) and new rule changes from the 2022 Inflation Reduction Act will kick in which will dramatically affect how much participants pay for their medications. (Note: It is still unclear how some of these changes will be implemented. We will be sending you more information as it becomes available).
Here are the important changes you need to be aware of:
- Medicare will eliminate the Coverage Gap (Donut Hole). This was the level that when reached typically resulted in higher drug costs.
- New $2,000 out-of-pocket maximum for all covered medications. A big change for Part D enrollees will be the $2,000 out-of-pocket maximum per year for medications. Once you have spent $2,000 in drug costs for covered medications, you are done for the year.*
- New Medication payment plan option. A new payment plan option will allow you to pay for medications over the course of the year in the form of a payment plan instead of up front. The new “opt-in only” plan allows someone to spread the payments out for the remainder of the months in the year.
With these rule changes that could significantly shift costs to Part D drug plans there are concerns that premiums will increase dramatically. To curb this fear, CMS created a voluntarily premium-stabilization plan that will subsidize drug plans who participate. We will learn very soon how well this will curb rate increases.
IMPORTANT!! You will receive an Annual Notice of Change from your Medicare Part D drug plan very soon. It will inform you of changes in your drug plan for 2025. This will include changes in plan premiums, deductibles and co-pays, and whether the plan will even be offered next year. It will also share whether your prescriptions will be covered and, if so, how much your share of costs will be. It is very important to read this notice thoroughly.
More to come!
Phil Dougherty, OnlyHealthInsurance
* This cap does not apply to out-of-pocket spending on Part B drugs. Medicare Part B covers drugs that are administered by a doctor, nurse, or other healthcare provider in an outpatient setting such as a doctor’s office.